Provider Purchasing and Contracting for Health Services_The Case

The memorandum of understanding gives management boards administered by churches the
same powers as those established under the National Health Services Act of 1995. The parties
further agreed that the majority of the members of the management board established under
this memorandum of understanding are to be nominated by the managing church and
thereafter by the minister of health. Representative churches in the health institutions would
be nominated to sit on the district health boards of the districts that have church-related
institutions. The parties also agreed that the heads of the government and church hospitals
who are not members of management boards would be members of the District Health
Management Teams in the districts where they are stationed.
Generally, mission hospital boards are more autonomous than their Ministry of Health
counterparts. For example, mission hospitals may have accounts abroad and procure drugs
own their own (Ndonyo 2005).
6. Contracting Models in Zambia
Contracting in health services in Zambia occurs at various levels and among different players.
As table 9 shows, contracting occurs within the public sector and between the public sector
and the private for-profit and private not-for-profit providers. Further, private for-profit
providers also contract with the public and private not-for-profit sectors for some health
services. The private sector providers also contract with each other for some services. This
section discusses contracting arrangements based on literature reviews and interviews with
various actors in the health system from the public and private sectors.
Contracting in the public sector: Purchaser-provider design
Contracting was adopted as part of the economy-wide reforms to enhance efficiency and
resource allocation with the goal of improving service delivery. Prior to the 2005 institutional
reforms, several contracting models existed in Zambia. See table 9 below.
Table 9: Services and types of actors in contracting
Type of Service or Function
Contracted
Type
Clinical,
nonclinical,
management,
finance,
systems, etc.
Clinical
Mode of
Contracting
Provision of
the BHCP
and other
interventions
Provision of
the BHCP
Actors in Contracting
Arrangements
Principal
Ministry of
Health
Agent
Central Board
of Health
Implementation
Monitoring and Evaluation
Mechanism
Strategic plan and national
indicators
CBoH HMBs Defined services and
interventions, accreditation
based on quality, quarterly
performance audit,
quarterly routing of HMIS
reporting, quarterly FAMS
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